Download Efficacy of random-start controlled ovarian stimulation for emergency

Efficacy of random-start controlled ovarian stimulation
for emergency fertility preservation in cancer patients
Controlled ovarian stimulation for oocyte or
embryo cryopreservation is the established
method for fertility preservation in cancer
patients. However, as there is often an urgent
need to start chemotherapy or radiotherapy, the
random-start
approach
of
commencing
controlled ovarian stimulation in the follicular or
luteal phase has been proposed to
cryopreserve oocytes or embryos. However,
there is still a paucity of data regarding the
viability of this approach for fertility
preservation.
Results
Results
Background
There was no difference in the ages, BMI or antral follicle count in the two groups.
In the random-start group most patients had breast (N=8), haematological and
gynaecological cancers while in the conventional-start group most patients had
breast cancer (N=61) followed by haematological, gastrointestinal and
gynaecological cancers.
There was no difference in the amount of gonadotrophins required (random-start:
2512 IU vs. conventional-start: 2118 IU) or the number of days of stimulation in the
two groups. The number of oocytes retrieved in the random-start group was
comparable to the conventional-start group (median: 8; range: 5-13 vs. 11; 5-16).
The number of mature oocytes retrieved also did not differ between the two groups
(random-start: 6, range: 2-12 vs. conventional-start: 8, range: 4-12).
Methods
Retrospective cohort study of cancer patients
undergoing fertility preservation in a single
centre over a 10-year duration. Patients who
underwent random-start controlled ovarian
stimulation (COS) (N=13) were compared to
patients
who
underwent
conventional
follicular start COS (N=115).
Post-chemotherapy or radiotherapy patients
were excluded. All patients underwent COS
with the GnRH antagonist protocol. Random
start COS was started in either the follicular
or luteal phase of the menstrual cycle.
Setting: University tertiary centre.
Table 1. Treatment outcome for random-start vs. conventional-start
controlled ovarian stimulation in cancer patients
Parameters
Conventional start
(N=115)
Random start
(N=13)
P-value
Amount of gonadotrophins
required (IU)
2118 (1500-3000)
2512 (1500-3900)
0.56
Number of days of stimulation
10 (9-12)
11(10-12)
0.28
Number of oocytes retrieved
11(5-16)
8 (5-13)
0.23
Number of mature oocytes
8 (4-12)
6 (2-12)
0.33
Values represent median and inter-quartile range
Random start
Conventional
start
P = 0.23
Figure 1. Number of oocytes retrieved
Conclusion
The efficacy of random-start controlled
ovarian stimulation is comparable to
conventional-start
controlled
ovarian
stimulation in patients with cancer undergoing
fertility preservation treatment.
This urgent approach is a viable option for
cancer patients when there is an urgent need
to commence potentially gonadotoxic cancer
treatment.
References
1.Cakmak H, Katz A, Cedars MI, Rosen MP. Effective
method for emergency fertility preservation: randomstart controlled ovarian stimulation. Fertility and
sterility;100:1673-80.
2.Sönmezer M, Türkçüoğlu I, Coşkun U, Oktay K.
Random-start controlled ovarian hyperstimulation for
emergency fertility preservation in letrozole cycles.
Fertility and sterility;95:2125.e9-.e11.